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NPI Code Detail

MEDICARE: MRS. ABIGAIL BROOKS CALLAHAN AC-PNP

MEDICARE: MRS. ABIGAIL BROOKS CALLAHAN AC-PNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerNP95001371CA
2363LP0200XPediatric Nurse Practitioner1146506TX

General Provider Information

NPI Number : 1649655317
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ABIGAIL BROOKS CALLAHAN AC-PNP
Provider Business Mailing Address
First Line : 110 N CLEARWATER DR
Second Line :
City : HIGHLAND VILLAGE
State : TX
Zip : 75077-6718
Country : US
Telephone Number : 619-723-3895
Fax Number :
Provider Business Practice Location Address
First Line : 9525 GREENVILLE AVE
Second Line :
City : DALLAS
State : TX
Zip : 75243-4116
Country : US
Telephone Number : 281-409-6011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2015
Last Update Date : 03/14/2025

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